Healthcare Provider Details

I. General information

NPI: 1447106901
Provider Name (Legal Business Name): EDDIE GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 URBANA DR APT 227
ORLANDO FL
32837-7753
US

IV. Provider business mailing address

4301 URBANA DR APT 227
ORLANDO FL
32837-7753
US

V. Phone/Fax

Practice location:
  • Phone: 407-427-0243
  • Fax:
Mailing address:
  • Phone: 407-427-0243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: